part 11

[Virtual Presenter] Welcome everyone to this presentation on the requirements, standards, and documentation procedures for providing physical therapy services. Today, our focus will be on the P-C-I-S-P and the importance of appropriate assessment and authorization for these services. To begin with, let us first understand what we mean by PCISP. This is a comprehensive document that outlines the requirements and standards for providing physical therapy services under the F-S-W and C-I-H waivers. Our presentation will focus on the reimbursable activities for physical therapy services. These include screening and assessment, treatment and training programs, direct therapeutic intervention, training and assistance with adaptive aids and devices, and consultation or demonstration of techniques with other service providers and family members. We also have specific documentation standards that must be met. Physical therapy services documentation must include documentation by appropriate assessment. This ensures that the need for these services is justified and authorized in the PCISP. Finally, we have service standards that apply to physical therapy. It is mandatory for individual physical therapy services to be reflected in the PCISP, regardless of the funding source. This emphasizes the importance of proper documentation and authorization of these services. In conclusion, our presentation outlines the necessary guidelines for providing physical therapy services under the F-S-W and C-I-H waivers. It is important to adhere to these guidelines and ensure proper documentation and authorization for the benefit of the individual receiving these services. Thank you for your attention, and please stay tuned for the remaining slides of this presentation..

[Audio] Welcome to our presentation on the requirements, standards, and documentation procedures for providing physical therapy services. In this section, we will discuss the P-C-I-S-P and the need for appropriate assessment and authorization. It's important to note that this waiver service is only available to individuals aged 21 and over. Children under the age of 21 can receive medically necessary physical therapy services through the Indiana Medicaid State Plan. When billing for therapy services, a minimum of 45 minutes of direct individual care must be provided within one hour. The following activities are not allowed under physical therapy: therapy services within an educational or school setting, activities delivered in a nursing facility, and services already covered under the Indiana Medicaid State Plan. In order to receive reimbursement through the waiver, a Medicaid State Plan PA denial is required. To become a provider for physical therapy services under the waiver, you must be enrolled as an active Medicaid provider and be FSSA DDRS-approved. Additionally, you must comply with the Indiana Administrative Code. Thank you for joining us for this overview of the requirements, standards, and procedures for providing physical therapy services. We hope this information has been helpful and we look forward to answering any questions you may have..

[Audio] We will discuss the requirements, standards, and documentation procedures for providing physical therapy services under the F-S-W and C-I-H waivers. Specifically, we will focus on the P-C-I-S-P and the importance of appropriate assessment and authorization. This slide falls under Section 10 of the DDRS HCBS waivers, which covers service definitions and requirements for F-S-W and C-I-H waivers. We will be looking at Section 10.20, which deals with Prevocational Services for F-S-W and C-I-H waivers. Prevocational Services are supports that prepare individuals for paid employment and are intended to be a time-limited service along the continuum of employment supports. The purpose of these services is to develop or improve job and non-job skills, and increase preparedness for competitive integrated employment through learning and work experiences. These services must be prevocational in nature and not vocational, meaning they do not focus on specific job tasks but rather on achieving a generalized result. They may also include activities aimed at underlying habilitative goals rather than teaching specific job skills. Participants in this service are compensated at less than 50% of the minimum wage. It is important to document the use of Prevocational Services and ensure that they support the individual's stated employment outcomes in their PCISP. The ultimate goal of these services is to develop and teach general skills that will lead to competitive and integrated employment, such as effective communication with supervisors, coworkers, and customers, and generally accepted community workplace conduct. Thank you for listening to this overview of Prevocational Services for F-S-W and C-I-H waivers. Stay tuned for the next slide..

[Audio] Today, we will be discussing a document that outlines the requirements, standards, and documentation procedures for providing physical therapy services under the F-S-W and C-I-H waivers. The focus of our discussion will be on the P-C-I-S-P and the need for appropriate assessment and authorization. In Section 10, titled Service Definitions and Requirements for F-S-W and C-I-H Waivers, several reimbursable activities under Prevocational Services are listed. These include monitoring, training, education, demonstration, or support to assist individuals in acquiring and retaining skills in areas such as paid and unpaid training at less than 50% of the federal minimum wage, as well as generalized and transferrable employment skills acquisition. These activities can be provided through offsite enclave or mobile community work crew models. It is important to note that all Prevocational Services must be reflected in the PCISP. Additionally, these services should be reflected in the individual's plan of care as directed to habilitative rather than explicit employment objectives. This means that the focus is on developing skills and abilities rather than immediate employment opportunities. It is not expected that an individual will be able to join the general workforce or participate in sheltered employment within one year of receiving Prevocational Services. It is a process and progress towards these goals will be carefully monitored and documented. Speaking of documentation, it is crucial that Prevocational Services documentation includes the services outlined in the PCISP. In addition to this, compliance with documentation requirements outlined in 460 IAC 6 is necessary. This includes specific data elements such as the name and I-H-C-P Member ID of the individual receiving services, the name of the provider, the service rendered, the time frame of service, and the date of service including the year. It is also important to note the primary location of service delivery and provide a brief activity summary of the service rendered. Furthermore, direct care staff must document any issues or circumstances concerning the individual. Thank you for your attention to these service and documentation standards for Prevocational Services under the F-S-W and C-I-H waivers. Please continue to follow along as we discuss the remaining sections of the document. Thank you..

[Audio] We are discussing the requirements for F-S-W and C-I-H Waivers Physical Therapy Services under the DDRS HCBS Waivers. There are specific guidelines and procedures for providing physical therapy services. These include the PCISP, which focuses on appropriate assessment and authorization. For Group Services, the provider must ensure that the ratio for each claimed time frame of service does not exceed the maximum allowable ratio, regardless of whether all group individuals are using a waiver funding stream. There are limitations on group sizes for Prevocational Services, with small groups having a ratio of 4:1 or smaller, medium groups having a ratio of 5:1 to 10:1, and larger groups having a ratio of larger than 10:1 but no larger than 16:1. This is a time-limited service, with a maximum of 18 months throughout a participant's time on the waiver. Exceptions to this limit will only be made on a case-by-case basis after careful consideration and alignment with the participant's individualized transition plan. Any extension of the service beyond 18 months must be accompanied by a plan for transitioning to competitive, integrated employment or another appropriate waiver service. This plan will be revisited and updated by the individual and their Individualized Support Team (I-S-T--) at least every six months, with progress toward transition as a necessary precursor for an extension. Monitoring occurs on a quarterly basis, including assessing progress towards employment goals, evaluating the appropriateness of the service, and seeking input from the individual's ISt The main objective of monitoring is to assess the individual's progress towards achieving the outcomes outlined in their P-C-I-S-P related to employment and to verify the continued need for Prevocational Services. It is important to stay informed and adhere to these guidelines for the best care and support of our participants..

[Audio] We are currently on slide 14 of the presentation, discussing the necessary requirements, standards, and documentation procedures for providing physical therapy services under the F-S-W and C-I-H waivers. Our focus today is on the P-C-I-S-P and the importance of appropriate assessment and authorization. To begin, we will be talking about the qualifications required for physical therapy providers under these waivers. These providers must meet the following criteria: Be actively enrolled as a Medicaid provider Be approved by F-S-S-A D-D-R-S Comply with the guidelines set by Indiana Administrative Code, 460 I-A-C 6, including but not limited to: documentation of criminal histories, insurance, and financial status of providers. Additionally, they must also adhere to any applicable B-D-S service standards, guidelines, policies, and/or manuals, including FSSA DDRS policies and the module accessible on the I-H-C-P Provider Reference Modules page at in.gov/medicaid/providers. Furthermore, they must obtain and maintain accreditation from at least one of the following organizations: The Commission on Accreditation of Rehabilitation Facilities (C-A-R-F-) or its successor The Council on Quality and Leadership in Supports for People with Disabilities or its successor The Joint Commission on Accreditation of Healthcare Organizations (J-C-A-H-O) or its successor The National Committee for Quality Assurance or its successor The ISO-9001 human services quality assurance (Q-A---) system An independent national accreditation organization approved by the F-S-S-A Secretary Aside from discussing the provider qualifications, we will also touch upon the requirements for psychological therapy services under the F-S-W and C-I-H waivers. These services are provided by a licensed psychologist with an endorsement as a health service provider in psychology (H-S-P-P-), a licensed marriage and family therapist, a licensed clinical social worker, or a licensed mental health counselor. It's important to note that these services cannot be used as a substitute for those offered under the Indiana Medicaid State Plan. These waiver services are only available to individuals aged 21 and above, while medically necessary Psychological Therapy services for children under 21 are covered under the state plan benefit in accordance with the E-P-S-D-T benefit. To conclude, we will provide a summary of the key points discussed and answer any questions you may have. Thank you for joining us for this presentation..

[Audio] We are now on our seventh slide of our presentation, where we will be discussing the requirements, standards, and documentation procedures for providing physical therapy services under the F-S-W and C-I-H waivers. Our focus will be on the P-C-I-S-P and the need for appropriate assessment and authorization. Under the DDRS HCBS waivers, there are certain reimbursable activities for Psychological Therapy. These include individual counseling, biofeedback, individual-centered therapy, cognitive behavioral therapy, psychiatric services, crisis counseling, family counseling, group counseling, substance abuse counseling and intervention. Additionally, planning, reporting, and write-up are also reimbursable when in association with the actual one-on-one direct care or therapy service delivery with the waiver individual. It is important to note that therapy services should be reflected in the P-C-I-S-P of the individuals regardless of the funding source. This means that regardless of whether the service is under the Indiana Medicaid State Plan or the waiver, it must be included in the PCISP. Furthermore, these services must address the needs identified in the person-centered planning process and must complement other services received by the individuals, with the ultimate goal of increasing independence. Moving on to documentation standards, it is crucial that all Psychological Therapy services are properly documented. This includes appropriate assessments, outlining services in the PCISP, and providing the necessary credentials for the service provider. In addition, attendance records, therapist logs, and/or charts must be kept to detail the services provided, dates, and times. It is also important to ensure that all documentation is in compliance with 460 IAC 6 Supported Living Services and Supports requirements. And finally, for those services requested on the Indiana Medicaid State Plan, it is imperative that they are also included in the PCISP. Lastly, it is important to note that as applicable, monthly or quarterly reports must be uploaded to the document library of the state's case management system by the chosen service provider on or before the 15th day of the month. This is to ensure that all documentation is up to date and in compliance with the necessary standards..

[Audio] We continue our discussion on the requirements, standards, and documentation procedures for providing physical therapy services under the F-S-W and C-I-H waivers. Now, we turn our attention to Section 10, which focuses on service definitions and limitations. It's important to note that this waiver service is only available to individuals ages 21 and over. Any medically necessary psychological therapy services for children under the age of 21 are covered by the Indiana Medicaid State Plan benefit under the E-P-S-D-T program. When it comes to billing for therapy services, it's important to remember that one hour of billed therapy must include a minimum of 45 minutes of direct individual care, with the remaining 15 minutes spent on related patient services. However, there are certain activities that are not allowed under Psychological Therapy. This includes activities delivered in a nursing facility, services already covered under the Indiana Medicaid State Plan (which requires a Medicaid State Plan PA denial before reimbursement can be obtained through the waiver), and therapy services provided within an educational or school setting. It's also worth noting that services provided by the parent of a minor child or the spouse of a participant, also known as L-R-I-s-, are not allowed. This service is specifically designed to prevent duplication of therapies provided under any other service. Therefore, it is crucial that providers comply with the following qualifications. First and foremost, providers must be enrolled as an active Medicaid provider and be FSSA DDRS-approved. They must also comply with Indiana Administrative Code, 460 I-A-C 6, which includes documentation of criminal histories, insurance requirements, and financial status. Additionally, providers must meet any applicable B-D-S service standards, guidelines, and policies, including FSSA DDRS policies and this module. It's important for providers to review and fully understand these qualifications to ensure quality and appropriate services are provided to individuals. Thank you for listening and don't hesitate to reach out to us for any further clarification..

[Audio] We will discuss the requirements and standards for providing physical therapy services under the F-S-W and C-I-H waivers, which is covered in slide 9 of our presentation. We will focus on the P-C-I-S-P and the importance of appropriate assessment and authorization. Recreational Therapy services fall under section 10.22 of the DDRS HCBS waivers, with a service definition outlined in 460 I-A-C 6-3-43. These services aim to restore, remediate, or rehabilitate an individual's functioning and independence, as well as reduce or eliminate the effects of their disability. Examples of reimbursable activities under Recreational Therapy include organizing and directing adapted sports, dramatics, arts and crafts, and social activities. Planning, reporting, and write-up services are also reimbursable when conducted in association with the actual one-on-one direct care/therapy service delivery with the waiver individual. We have set certain service standards for Recreational Therapy to ensure quality services for our clients. These standards should be reflected in the P-C-I-S-P and address the needs identified in the person-centered planning process. Furthermore, these services should complement other services the individual receives and promote increasing independence. Documentation standards for Recreational Therapy services include appropriate assessment, outlining services in PCISP, and providing appropriate credentials for the service provider. An attendance record should also be maintained. Thank you for your attention to this important information regarding Recreational Therapy services for the F-S-W and C-I-H waivers. On the next slide, we will discuss the documentation standards for other services provided under the Indiana Medicaid State Plan and the waiver..

[Audio] We will discuss the service definitions and requirements for both F-S-W and C-I-H waivers, with a specific focus on P-C-I-S-P and appropriate assessment and authorization. Within this section, we will also mention Recreational Therapy services. However, there are limitations to these services that need to be understood. Firstly, services provided under the waiver cannot be used as a substitute for those covered under the Indiana Medicaid State Plan, ensuring that individuals receive the necessary and appropriate care for their specific needs. Additionally, group services are limited to a maximum of four individuals per recreational therapist, determined by dividing the unit rate by the number of individuals served. One hour of billed therapy service must include at least 45 minutes of direct individual care, with the remaining time spent on related individual services. Certain activities such as payment for the cost of recreational activities, registrations, memberships, or admission fees associated with the planned, organized, or directed activities are not allowed as part of Recreational Therapy. Any services that are already reimbursable through the Indiana Medicaid State Plan are not covered under this waiver. Furthermore, therapy services cannot be provided within the educational or school setting or as a component of an individual's school day. The size of group services should not exceed the maximum allowable group size determined by the Interdisciplinary Support Team (I-S-T--) for each individual in the group. Group services should only be provided when the I-S-T has determined it to be appropriate for each individual in the group, ensuring that individuals receive the most effective and personalized care. Providers of Recreational Therapy services must meet certain qualifications, including being enrolled as an active Medicaid provider and being FSSA DDRS-approved. Providers must also comply with the Indiana Administrative Code, specifically 460 I-A-C 6-10-5 D Thank you for your attention to this important information regarding Recreational Therapy services under the F-S-W and C-I-H waivers. By following these guidelines and limitations, we can ensure that individuals receive the best possible care and support..

[Audio] We are now on slide number 11, out of 14, in our presentation on the DDRS HCBS Waivers. This slide covers the service definition and requirements of Remote Supports for F-S-W and C-I-H Waivers. Remote Supports is a comprehensive service that uses technology-based tools to provide live support to individuals from a remote location. This allows trained remote support professionals, or R-S-P-s-, to assist individuals instead of being on-site. The main responsibility of R-S-Ps is to provide Remote Supports from a secure remote support facility provided by the provider. To ensure the safety and confidentiality of our clients, this facility must have stable and redundant connections, including backup generators, multiple internet service connections, and battery backups. Remote Supports also includes oversight and monitoring within the residential setting for adult waiver participants and minors aged 14 to 17, through the use of technology such as two-way communication systems and sensors. It is important to note that for minors, Remote Supports are used to encourage appropriate independence, not to replace parental supervision. The ultimate goal of Remote Supports is to promote independence and security for our clients by combining technology and services to provide direct contact with trained staff whenever needed. This fosters a sense of security and allows for the development of life skills and increased independence. For those who are transitioning to independent living, Remote Supports can also assist in this process by enhancing self-advocacy skills and providing opportunities for community participation. It is important to note that Remote Supports can be used with both paid and unpaid backup support, as specified in the F-S-W and C-I-H Waivers. This ensures that our clients have the necessary support to live independently while maintaining their sense of security. Thank you for listening to this overview of Remote Supports. We will now move on to our next topic, and please feel free to ask any questions during the Q&A session at the end of the presentation..

[Audio] Assessment and informed consent are critical for the provision of physical therapy services under the DDRS HCBS waivers. Careful consideration and adherence to specific standards and requirements are necessary. As described in Section 10, the unit rate for Remote Supports services is divided among the number of waiver individuals present in the home during each hour of service. This only applies to individuals who have Remote Supports included in their plan. In addition to this, it is imperative that the remote support system is designed and implemented with the individual's independence, health, and safety in mind. The case manager and/or B-D-S service coordinator will conduct reviews at seven and 14 calendar days after the installation to ensure that the system meets these standards. The remote support service requires both assessment and informed consent. Informed consent must be obtained from the individual using the service, their guardian, and other individuals and their guardians residing in the home. This consent must clearly state the parameters in which the remote support service will be used. Moreover, all individuals, guardians, and I-S-T must be fully informed about the benefits and risks associated with the operating parameters and limitations of the remote support service. The remote support provider conducts an assessment, with input from the individual and their I-S-T--, to determine the best location for the devices or monitors to meet the individual's needs. The individual's personal control and use of the equipment will be reflected in their PCISP. It is the responsibility of the remote support provider to inform the individual of the equipment's operation and usage. Finally, all informed consent documents must be acknowledged in writing and signed and dated by the individual, guardian, case manager, and provider. It is crucial to ensure that assessment and informed consent are properly obtained and considered for the successful implementation of remote support services under the DDRS HCBS waivers..

[Audio] Moving on to slide number 13, we will be discussing the requirements and standards for providing physical therapy services under the DDRS HCBS waivers. Our focus will be on the P-C-I-S-P and the importance of appropriate assessment and authorization. In Section 10 of the presentation, we will outline the specific service definitions and requirements for the F-S-W and C-I-H waivers. When implementing a remote supports system to replace in-person direct support services, certain safeguards and backup procedures must be in place. Firstly, the provider is responsible for having backup systems (such as batteries and generators) to ensure that electronic devices remain functional during electrical outages. This applies to both the remote supports monitoring base and the individual's residential living sites. Additionally, there must be backup procedures in case of system failure, fire or weather emergencies, individual medical issues, or personal emergencies. These procedures should be documented for each site using the system, as well as for each individual's PCISP. It is crucial that these plans specify the staff members responsible for responding to these situations and traveling to the individual's living site, including any identified backup support responder. Furthermore, the remote supports system must be able to receive notifications from smoke or heat alarms at each individual's residential living site. This is essential for ensuring the safety and well-being of the individuals being monitored. In order to effectively interact with and address the needs of individuals in each living site, the remote supports system must have two-way audio communication capabilities. This is especially important in emergency situations where the individual may not be able to use the phone. Lastly, the system must allow the monitoring base staff to have visual oversight of specific areas in an individual's living site as deemed necessary by the ISt It is important to note that a remote supports monitoring base cannot be located in an individual's residential living site. This is to protect the privacy and independence of the individuals being monitored. Thank you for your attention, and now we can move on to the final slide of our presentation..

[Audio] Our presentation is focused on the requirements, standards, and documentation procedures for providing physical therapy services under the F-S-W and C-I-H waivers, with a specific emphasis on the P-C-I-S-P and the need for appropriate assessment and authorization. As we move to slide 14, we want to highlight the importance of real-time monitoring and backup support for individuals who receive services in their homes. The remote supports monitoring base staff will stay engaged with the individuals in their homes during urgent situations until backup staff or emergency personnel arrive. If computer vision or video is used, oversight must be done in real-time by an awake staff member at a remote location using telecommunications or broadband connections. The remote supports monitoring base must keep a file on each individual in each home monitored, including a current photograph and pertinent information to ensure their safety. This file must be updated at least annually. The remote supports monitoring base staff must also have detailed and up-to-date protocols for responding to the needs of each individual, including contact information for on-site support at their residential living site when necessary. As for backup support, the following are requirements: backup support must respond and arrive at the individual's residential living site within 20 minutes of the incident being identified by remote staff, and they must acknowledge receipt of the notification. The I-S-T has the authority to set a shorter response time based on the individual's needs. Backup support must be provided by one support person for on-site response, and the number of individuals served by that backup support must be determined by the I-S-T based on their assessed needs in specific locations. In cases where backup support is needed, they will assist the individual in their home until the urgent need or issue is resolved. If necessary, relief for backup support must be provided by the residential habilitation provider. In terms of documentation, the following must be included:.